Healthcare Provider Details

I. General information

NPI: 1447223037
Provider Name (Legal Business Name): KATHERINE R. STEVENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AMERICAN AVE FL 3 PROHEALTH CARE MEDICAL ASSOCIATES, INC.
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

725 AMERICAN AVE FL 3 PROHEALTH CARE WOMEN'S CENTER
WAUKESHA WI
53188-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-2594
  • Fax:
Mailing address:
  • Phone: 262-928-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number38174
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38174
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: